The Club House, Inc.

                                                          8393 Page Ave.

                                                          St. Louis, Mo.  63130

                                                          1-866-379-2582 Toll Free

                                                          314-743-2300 Direct

                                                          314-743-0728 FAX

                                                          www.theclubhouseinc.com            

Make: ______________________ Model: ______________________________ Year: __________

SOLD TO:

SHIP TO: (if different from Sold To)

Name:

Name:

Address:

 

Address:

City:

City:

State:                                            Zip:

State:                                            Zip:

Daytime Phone: (         )

Daytime Phone: (         )

QTY.

Fabric Color

Description

Price/Ea.

Extension

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Merchandise Total 

Add 6.825% Sales Tax (MO Only)                                                            

Call 1-866-379-2582 for Delivery Charges 

Grand Total 

 

 

 

 

Check or Money Order Enclosed

Charge to my:

MasterCard VISA      AMEX

Credit Card Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expiration Month

Expiration Year

 

 

Contact Name: _____________________ Purchase Order #_______________________


For overnight shipments, call for quote.